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目的观察不同血液净化方式对艾滋病合并马尔尼菲青霉病所致多脏器功能衰竭预后的影响。方法回顾性分析南宁市第四人民医院2011年6月~2013年6月收治的艾滋病合并马尔尼菲青霉病出现多脏器功能衰竭(MODS)31例患者。根据患者行血液净化治疗的不同方式将患者分为(1)连续性静脉-静脉血液滤过(CVVH)组;(2)连续性静脉-静脉血液滤过+血液灌流(CVVH+HP)组;(3)连续性高容量血液滤过(HVHF)组,分别对治疗前后肌酐、尿素氮、转氨酶、白细胞、红细胞、血小板等指标进行分析。结果三组治疗后肌酐、尿素氮、转氨酶、APACHEⅡ评分、白细胞、血沉、C反应蛋白均明显下降(P均<0.05);HVHF组较其他两组APACHEⅡ评分明显改善(P<0.05),三组生存率无显著性差异(P>0.05);但死亡病人的存活时间HVHF组明显优于其他两组(P<0.05)。结论 CVVH、CVVH+HD、HVHF三种模式均能清除炎症介质、调节机体电解质及内环境,HVHF较其他两种模式更能改善青霉病患者脏器功能的指标。
Objective To observe the effect of different methods of blood purification on the prognosis of multiple organ failure caused by AIDS virus combined with Penicillium marneffei. Methods A retrospective analysis of 31 patients with multiple organ failure (MODS) in HIV / AIDS Penicillitis marneffei from June 2011 to June 2013 in Nanning Fourth People’s Hospital was retrospectively analyzed. Patients were divided into (1) CVVH group, (2) CVVH + HP group, and (2) CVVH + HP group according to different methods of blood purification treatment. (3) In continuous high volume hemofiltration (HVHF) group, creatinine, urea nitrogen, aminotransferase, white blood cell, erythrocyte and platelet were analyzed before and after treatment respectively. Results The levels of creatinine, urea nitrogen, aminotransferase, APACHEⅡscore, leukocyte, erythrocyte sedimentation rate and C-reactive protein in the three groups were significantly decreased (all P <0.05). The APACHEⅡ scores of HVHF group were significantly improved compared with the other two groups There was no significant difference in survival rate between the two groups (P> 0.05). However, the survival time of the deceased patients was significantly higher than that of the other two groups (P <0.05). Conclusion CVVH, CVVH + HD and HVHF all can clear the inflammatory mediators and regulate the body electrolyte and internal environment. HVHF can improve the organ function of penicillin than the other two modes.